P77. Enhanced recovery after surgery reduces postoperative opioid use and 30-day readmission rates after open thoracolumbar fusion for adult degenerative scoliosis

Abstract

BACKGROUND CONTEXT Enhanced Recovery After Surgery (ERAS) programs have been consistently shown to reduce surgical complications, decrease hospital costs and improve patient-reported outcomes across multiple surgical specialties. This benefit has been shown to be applicable to surgical spinal procedures, and to reduce hospital length of stay and decrease overall surgery costs. However, most publications to date offer heterogeneous data with a mix of patients undergoing minor procedures such as minimally invasive discectomies, and others undergoing multiple level thoracic or lumbar fusions. The aim of our analysis was to assess the impact of ERAS pathways implementation in an older population undergoing open thoracolumbar fusion for degenerative scoliosis. PURPOSE Determine the impact of Enhanced Recovery After Surgery (ERAS) pathways implementation on postoperative outcome, opioid consumption, and unplanned readmission rates in adult patients undergoing open thoraco-lumbar-pelvic fusion for degenerative scoliosis. STUDY DESIGN/SETTING This study was conducted at a single academic spine center. All patients undergoing spine surgery had their data prospectively collected within our spine registry. Patient data was retrospectively reviewed for the years 2016 and 2017 prior to the implementation of our ERAS protocol, and then 2018 and 2019 after its implementation for all thoracolumbar degenerative procedures that were performed during that timeframe. PATIENT SAMPLE All subjects included in the analysis underwent long segment thoraco-lumbar-pelvic fusion for adult degenerative scoliosis. OUTCOME MEASURES Primary outcomes consisted of postoperative supplementary opioid consumption in Morphine Equivalent Dose (MED), postoperative complications, and readmission rates within the postoperative 30-day window. METHODS In this retrospective single-center study, we included 124 consecutive patients who underwent open thoraco-lumbar-pelvic fusion from October 2016 to February 2019 for degenerative scoliosis. Patient demographic information included age, weight and body mass index. The operative parameters comprised the number of segments fused, the Cobb angle of the deformity, operative time, anesthesia duration and intraoperative blood loss volume. Primary patient outcomes consisted of supplemental total opioid intake in addition to standard intravenous or epidural patient-controlled analgesia for the duration of postoperative hospital stay in Morphine Equivalent Dosage (MED), postoperative complications and readmission rates within the postoperative 30-day window. RESULTS There were 67 patients in the ERAS group, and 57 patients served as pre-ERAS controls. Average patient age was 69 years. The groups had comparable demographic and intraoperative variables. ERAS patients had a significantly lower rate of postoperative supplemental opioid consumption (248.05 vs 314.05 MED, p=0.04), a lower rate of urinary retention requiring catheterization (5.97% vs 19.3%, p=0.024) and of severe constipation (1.49% vs 31.57%, p CONCLUSIONS A comprehensive multidisciplinary approach to complex spine surgery can reduce opioid intake, postoperative urinary retention and severe constipation, and unplanned 30-day readmissions in the elderly adult population. Our findings show that a comprehensive ERAS program can potentially decrease complications and improve outcomes in the adult and elderly population who suffer from scoliosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.